Friday, November 8, 2013

EDC Succeeds in Parity Push!

The EDC has worked tirelessly, in the past two years to put pressure on the Administration to release the regulations for the Mental Health Parity Addiction Equity Act of 2008 and to clarify that eating disorders must be covered at parity (click here for more).

This morning the Department of Health and Human Services released their final regulations on the Mental Health Parity and Addiction Equity Act of 2008. The EDC was part of a conversation this morning with HHS and the Substance Abuse Mental Health Services Administration where they outlined the final regulations. The EDC is excited about a number of the provisions.

While the final rule doesn’t require that residential services be covered, it does require that if a managed care organization (MCO) or health insurers offers “post-acute care services,” then they also must cover residential treatment and other intermediate services on the behavioral health side. Simply put, it means that if a health insurance plan covers chemotherapy [a post-acute oncology intervention after hospitalization], then it must cover residential treatment of substance use disorders or eating disorders. The rule ensures that parity applies to intermediate levels of care received in residential treatment or intensive outpatient settings.

Another, tremendous win for us, is that the final rule clarifies that parity applies to all plan standards, including geographic limits, family type limits, network adequacy. As many of you have encountered, you’ve needed to travel out of state to treatment centers so this is tremendous.

The EDC is particularly encouraged by the network disclosure requirements, the final rule will require that MCO’s/Insurers disclose medical necessity definitions and the process used to construct NQTL. This has long been a difficulty faced by people denied coverage for their eating disorders.

This is a tremendous victory for all of those who have struggled through getting insurance coverage at parity. Thank you to those who shared your stories with us, called your Members to advocate for parity, and of course, attended our lobby days. This is our victory together!

We are continuing to comb through the regulations, and will soon let you know what this all means for you. Stay tuned to our blog, or follow us on twitter, or like us on Facebook to get immediate updates.